This is Part 9 of the IVF Diary series. I’ll be keeping a diary of all important IVF days, starting from when we first chose to undergo infertility treatment in Prague. Click here to read all other IVF diary posts.

Oh boy, we’re almost there! This will be the last post before egg retrieval and I just can’t wait to find out what will happen next. First though, let’s summarize Day 8 until 13.

Growing Follicles

Growing follicles is what I’ve been doing the last few days. I haven’t experienced any of the typical symptoms that people generally report. I feel just fine. Hope it stays that way after egg retrieval! Anyway, I had my first scan a week ago, on Day 7. Since then, I’ve had 3 more for a total of 4 scans.

Day 10 Scan

The Day 10 scan revealed a couple more follicles on the left ovary and brought the total to 15 normal-sized ones and 9 small ones. The doctor (same one as I had on Day 7) scheduled me for a follow-up scan on Day 12 (last Saturday) to see how things were progressing, as the lead follicles were still below 18 mm. This is only to be expected for stimming just 9 days (and being on a very low dose). My endometrium was triple lined and it was still around 11 mm.

Day 12 Scan

We came back on Saturday and the clinic was pretty much empty. I’m thinking there were maybe 3-4 staff members and we didn’t see any other patients. The nurse informed us that the doctor was running late as he was in the middle of surgery, so I guess there was at least one other patient that day. The lead IVF doctor met us after about half an hour and spent some time reading my medical file. After that, it was feet up in the stirrups and time to bring out that lovely dildo cam. My lining now measured around 10 mm and a bit, instead of 11 and a bit, but the doctor told me that is within the margin of variation, considering two different doctors did the scans. The endometrium was still triple lined and looking good!

The follicles had grown a bit and the largest has now reached 20 mm. There were still quite a few that were in the intermediate range so the doctor advised to keep stabbing myself with Gonal-F for 2 additional days and I’d be ready to trigger on Monday. So I bought an extra Cetrotide ($43.40) and finished the last bit of Gonal-F I had left on Sunday. This brought the total number of days on Gonal-F to 12.

Day 14 Scan

I had my very last scan yesterday on Day 14. We met up with the lead IVF doc again and it was off to the stirrups. My endometrial lining measured 10 mm+ and was still looking trilaminar. The follicles (15 bigger ones, 7-9 smaller ones) were now large enough to trigger. The bigger ones were between 17 and 22 mm and the smaller ones were (you guessed it) less.

Risk of OHSS

The Day 14 scan was done mostly because the doctor wanted to see me again before triggering to make sure my body could handle doing an hCG trigger shot. As I have more than 20 follicles and a lot of other risk factors for ovarian hyperstimulation syndrome (OHSS), it’s important to be monitored carefully. OHSS can be life-threatening and as much as I like being in Prague, I’d rather not stay another week just to check out what their hospitals are like. Last week, an internet friend/IVF cycle buddy was hospitalized with OHSS and it sure doesn’t sound fun.

Triggering with hCG can lead to (early) OHSS, something that can be pretty much prevented if you use a GnRH-a trigger instead. The downside is that live birth rates are often lower (unless you freeze) due to inadequate luteal phase support, which is thought to cause an increase in miscarriage rates.

So ideally you’d want to trigger with hCG for a fresh transfer. But safety should always come first! The doctor determined I’d be okay using an hCG trigger unless my bloodwork shows crazy amounts of estrogen (estradiol, E2, to be specific). That being said, estradiol levels aren’t the best predictor of OHSS, and it’s hard to find a clear cutoff that is sensitive/specific enough to distinguish between those at risk and those that’d be fine. He said he usually bases the decision on whether or not to use an hCG trigger on the follicles themselves, and mine were still within the acceptable range.

The IVF Pre-Retrieval Instructions

Estradiol levels

So off I went to get my blood taken on the second floor. The nurse asked if I was good with needles. Good with needles? I know IVF is cheap in the Czech Republic, but they better not ask me to draw my own blood! Not what she meant of course, but that’s the way it played out in my head. Just as I was imagining left-handedly trying to find a good vein in my right arm, the nurse said “All done” and I was good to go!

My IVF coordinator made sure I’d still get the results back later that day, in case I needed to switch triggers and pick up a different trigger shot. Luckily, my hCG trigger was dirt cheap (125 CZK so about $5.80) so I didn’t mind buying it beforehand and just not use it in case I have to go pick up the other trigger.

My estradiol levels came back at 3,226 pmol/l. That’s just 878 pg/ml. Ouch! That’s really low. I spent the whole weekend worrying about rising estradiol levels while I should’ve been worried about my numbers being too low. There’s no way there’ll be 15 mature oocytes, based on these numbers I’d be lucky to get 4 or 5.

I don’t know why my eggs aren’t doing their job in producing estrogen. The follicles are big enough but are the eggs inside mature? We’ll see how many mature oocytes are found in these follicles, but I really have my doubts whether we’ll have enough to transfer an embryo next week.

The doctor still seems to think he can retrieve a bunch, but looking at the scientific literature, low estradiol levels don’t bode well.

This really sucks!

That being said, a first IVF cycle is always a bit of a trial and error, so at least we gain some important information. I’m sure my next protocol will be tailored more to my specific situation. A situation I didn’t even know I had. Well, at least we didn’t spend $15,000 or more doing IVF back home.

Tomorrow is D-day. I’m due for egg retrieval early in the morning. The whole procedure shouldn’t take more than 15-20 minutes or so, but they need to monitor me for a couple of hours afterward to see how I’m doing.

This is what the updated timeline looks like. Basically, compared to the original protocol I stimmed for one extra day, and I had two additional ultrasounds.